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BC: Articoli scritti da F. Tosato

Sicurezza del paziente e rischio clinico nel processo ematologico di laboratorio
Patient safety and clinical risk in the clinical laboratory haematological process
A. Aita \| F. Tosato \| F. Balboni \| A. Fanelli \| G. Da Rin \| M. Gioia \| S. Francione \| M.L. Ciardelli \| C. Scapellato \| R. Guerranti \| M. Quercioli \| P. Pezzati \| A. Tomei \| A. Bassi \| S. Buoro \|
<p> Patient safety, defined as the prevention of harm to patients, is the ultimate goal for medical laboratories. Risk management principles should therefore be considered an integral part of laboratory processes, especially of those activities directly impacting on patient care. This work aims to identify the most critical phases of haematological process and the risk reduction actions that improve patient safety. Risk analysis of the laboratory haematological process was carried out through Failure Mode, Effects and Analysis Criticality methodology. A form including the phases of the process, error modes and their possible effects, errors occurrence, detectability and severity scores and risk index (RI), has been prepared and sent to eight Italian laboratories. A multidisciplinary team performed the analysis in each laboratory, then two team leaders of the project comprehensively analysed the collected data. The process was divided in 8 phases (medical prescription, request acceptance, sample collection, transportation, reception and processing, results reporting and validation), 25 activities (17 pre-analytical, 4 intra-analytical, 4 post-analytical) and 43 failure modes. RI, calculated for each activity, ranged from 11 to 33. The most critical topics (RI >25) were: patient identification, peripheral blood smear review, interpretative comments and report validation. Staff training plays a central role in the entire laboratory haematological process and in the phases identified as critical. An effective management related to the attainment and maintenance of skills represents the best action in order to reduce risks of adverse events for patients. The promotion of procedures aimed to harmonize the interpretative comments and peripheral blood smear review is also pivotal</p><p> </p>
Biochimica Clinica ; 42(4) 300-312 Contributi Scientifici - Scientific Paper

Un caso di anemia multifattoriale
A case of anemia from intricate causes
F. Tosato \| E. Piva \| A. Schiavinato \| M. Plebani \|
<p>A 52 year old female, born in Ecuador, was admitted to the medical ward because of dizziness, blurred vision, sweating and vomiting started 3 days earlier. Complete blood count showed a severe anemia, while mean corpuscolar volume, mean corpuscolar hemoglobin, white blood cell, differential and platelet count were normal. Biochemical tests revealed a very high LDH and a low haptoglobin value. The blood smear revealed marked anisocytosis, hypocromia, oval erythrocytes, teardrop cells and fragments, with the presence of hypersegmented neuthrophils. These morphological features, together with the information obtained by the hematology analyzers, gave rise to the suspicion of vitamin B12 deficiency. Further investigation confirmed a low level of vitamin B12. Variant hemoglobin was detected by high performance liquid chromatography and capillary electrophoresis; an elevated soluble transferrin receptor value was observed. A diagnosis of sickle cell disorder associated to alpha thalassemia with iron and B12 deficiency was formulated.</p>
Biochimica Clinica ; 42(2) e18-e21 Casi clinici - Case report

Armonizzazione della diagnostica ematologica: lo stato della valutazione dei reticolociti
Harmonization in hematology: the status of reticulocyte count
E. Piva \| S. Secchiero \| F. Spolaore \| F. Tosato \| M. Plebani \|
<p>Harmonization is a crucial step in laboratory medicine to provide reliable information. The reticulocyte count and even more maturity parameters and indices seem to be still highly variable, despite their proven clinical usefulness. Three hematology analyzers (Siemens Advia 2120, Sysmex XN-1000, Mindray BC-6800) were used to assess reticulocyte count (percentage and absolute count), parameters and indices of blood samples from 82 adult patients. Results from 92 participant laboratories to the last 3 cycles (2012-2015) of EQA program of the Center of Biomedical Research were also evaluated. Statistical comparisons demonstrated an excellent correlation among the 3 instruments for reticulocyte count, both in percentage and absolute values. A systematic, not proportional difference in immature reticulocyte fraction results was observed between Advia 2120 and the other two analyzers, which conversely showed an excellent correlation between them. For the measurement of reticulocyte hemoglobin content, we found a systematic proportional difference between Advia 2120 and XN-1000, an excellent concordance between Advia 2120 and BC 6800 and a systematic not proportional difference between XN-1000 and BC 6800. Comparison between reticulocyte mean volume results obtained with Advia 2120 and BC 6800 showed a good correlation, even if systematic differences between the two methods were observed. For the reticulocyte counts the interlaboratory variability showed a CV Z10%, except for Advia 2120. EQA demonstrated the need of harmonization of reference intervals, which should go together with the harmonization of analytical methods for a correct clinical interpretation.</p>
Biochimica Clinica ; 40(3) 208-216 Contributi scientifici - Scientific Papers

Emoglobinuria parossistica notturna
Paroxysmal nocturnal hemoglobinuria
G. Pantano \| F. Tosato \| M.C. Sanzari \| M. Plebani \|
<p>Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired hematological disease of the hematopoietic stem cell. PNH arises as a consequence of non-malignant clonal expansion of hematopoietic stem cells and progeny mature blood cells of both myeloid and monocyte lineage, which are deficient in some surface proteins, including the two complement regulators CD55 and CD59. As a result, PNH erythrocytes are incapable to modulate on their surface physiologic complement activation, leading to complement-mediated intravascular hemolysis, which is the central clinical feature of PNH. Diagnosis and monitoring of PNH clones currently rely on the analysis of CD59 expression on red blood cells and FLAER (fluorescent aerolysin) and some glycophosphatidylinositol-anchored proteins on granulocyte and monocyte lineages by flow cytometry. Despite the availability of safe and effective targeted therapy that controls intravascular hemolysis, the management of PNH remains difficult because of disease heterogeneity and close association with bone marrow failure syndromes.</p>
Biochimica Clinica ; 37(4) 268-274 Rassegne - Reviews

Un caso di emoglobinuria parossistica notturna associata a mielodisplasia
A case of paroxysmal nocturnal hemoglobinuria in a patient with myelodysplasia
G. Pantano \| F. Tosato \| M.C. Sanzari \| C. Messina \| M. Plebani \|
<p>Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired hematological disease of the hematopoietic stem cell. PNH arises as a consequence of non-malignant clonal expansion of hematopoietic stem cells and progeny mature blood cells of both myeloid and monocyte lineage, which are deficient in some surface proteins, including the two complement regulators CD55 and CD59. As a result, PNH erythrocytes are incapable to modulate on their surface physiologic complement activation, leading to complement-mediated intravascular hemolysis, which is the central clinical feature of PNH. We present a case of a 16 years old Ukrainian boy who presented with a diagnosis of myelodysplastic syndrome and who was found to be affected by PNH.</p>
Biochimica Clinica ; 37(4) 326-328 Casi clinici - Case Report